
<?php echo "<!DOCTYPE html>
<html>
    <head>
        <meta charset='UTF-8' />
        <title>Sitio Reclamos</title>
        <meta content='width=device-width, initial-scale=1, maximum-scale=1, user-scalable=no' name='viewport'>      
        <!-- bootstrap 3.0.2 -->
        <link href=".$view['assets']->getUrl('bundles/cursomain/css/bootstrap.min.css')." rel='stylesheet' type='text/css' />
        <link href=".$view['assets']->getUrl('bundles/cursomain/css/font-awesome.min.css')." rel='stylesheet' type='text/css' />
        <link href=".$view['assets']->getUrl('bundles/cursomain/css/AdminLTE.css')." rel='stylesheet' type='text/css' />
        
    </head>
    <body  class='skin-blue'>
      <!-- Right side column. Contains the navbar and content of the page -->
            <aside class=''>
                <!-- Content Header (Page header) -->
                <section class='content-header'>
                    <h1>
                         Solicitud Numero:  
                    </h1>
                </section>
                
                 <!-- Small boxes (Stat box) -->
                    <div class='row'>
                    </div>
               		<!-- left column -->
                        <div class='col-md-12'>
                            <!-- general form elements -->
                            <div class='box box-primary'>
                                <div class='box-header'>
                                    <h3 class='box-title'>Datos Personales</h3>
                                </div><!-- /.box-header -->
                                <!-- form start -->
                                 <div class=''>
                                     <div class=''> 
                                        <div class='col-md-4'>
                                            <label for='exampleInputPassword1'>Numero Documento</label>
                                            <input type='text' name='numDocumento' class='form-control' id='exampleInputEmail1'>
                                        </div>
                                        <div class='col-md-4'>
                                            <label for='exampleInputPassword1'>Numero Telefonico</label>
                                            <input type='text' name='numTelefono' class='form-control' id='exampleInputEmail1' >
                                        </div>
                                         <div class='col-md-6'>
                                            <label for='exampleInputPassword1'>Nombres</label>
                                            <input type='text' name='nombresPersona' class='form-control' id='exampleInputEmail1' >
                                        </div>
                                        <div class='col-md-6'>
                                            <label for='exampleInputPassword1'>Apellidos</label>
                                            <input type='text' name='apellidos' class='form-control' id='exampleInputEmail1'>
                                        </div>
                                        
                                        <!-- Comienzan campos para ingresar datos de la  empresa -->
                                 
                                        <h3 class='box-header col-md-12'>Datos de Empresa </h3>
                         
                                        <div class='col-md-6'>
                                            <label for='exampleInputPassword1'>Nombre de Empresa</label>
                                            <input type='text' name='nombreEmpresa' class='form-control' id='exampleInputEmail1' >
                                        </div>
                                        <div class='col-md-3'>
                                            <label for='exampleInputPassword1'>Tipo Empresa</label>
                                            <input type='text' name='nombreEmpresa' class='form-control' id='exampleInputEmail1' >
        		                            
                                        </div>  
                                        
                                        <h3 class='box-header col-md-12'>Detalles de la Solicitud</h3>
                                        
                                        
                                        <div class='col-md-6'>
                                            <label for='exampleInputPassword1'>Titulo</label>
                                            <input type='text' name='titulo' class='form-control' id='exampleInputEmail1'>
                                        </div>
                                        
                                        <!-- Area de detalle -->
                                        <div class='col-md-6'>
                                                                                   
                                            <label>Detalle</label>
                                            <textarea class='form-control' name='descripcion' rows='3' placeholder='Detalle de solictud' required maxlength='200'></textarea>
                                        
                                        </div> 
                                        
                           				 <!-- Fecha de Solicitud -->
                               	    	 <div class='col-md-6'>
                                     	   <label>Fecha Solicitud</label>
                                     	   <div class='input-group'>
                                        	    <div class='input-group-addon'>
                                                <i class='fa fa-calendar'></i>
                                      	      </div>
                                     	       <input type='text' name='fecha' class='form-control'/>
                                  		      </div><!-- /.input group -->
                                 		   </div><!-- /.form group -->

                                 </div><!-- Termina el form group -->
                                </form>
                             
                           </div><!-- /.box -->
                       </div><!-- /.box-body --> 
                    </div>
                
            </aside><!-- /.right-side -->
        </div><!-- ./wrapper --> 
        <script src='http://ajax.googleapis.com/ajax/libs/jquery/2.0.2/jquery.min.js'></script> 
        <script src=".$view['assets']->getUrl('bundles/cursomain/js/bootstrap.min.js')." type='text/javascript'></script>
        <script src=".$view['assets']->getUrl('bundles/cursomain/js/AdminLTE/app.js')." type='text/javascript'></script>    
    </body>
</html> "; ?>